The candidate, Dr. Sheela Shenoi, completed her fellowship in Infectious Diseases in June 2009 and is currently an Instructor in the Department of Medicine, Section of Infectious Diseases, at Yale University. Her long term career goal is to conduct patient-oriented global HIV and TB research in an academic setting. The goal of her Mentored Patient-Oriented Research award is to acquire the needed skills and protected time to conduct and publish her research in order to effectively transition into an independent investigator. To accomplish this, she has crafted a comprehensive training plan in an academic U.S. and international setting. This consists of an innovative research project in rural South Africa, complimented by carefully selected courses at the Yale School of Public Health to expand expertise in quantitative and epidemiologic methods, and supervision and training by an expert team of mentors. She will balance the K23 award period between New Haven and South Africa. Dr. Shenoi's research takes place in South Africa, where TB rates are nearly three hundred times the levels in the U.S. South Africa also carries the largest global burden of HIV/TB coinfection, with consequent high rates of morbidity and mortality and severe implications for TB control and HIV antiretroviral therapy roll out programs. An emerging third epidemic of drug resistant tuberculosis has had additional devastating consequences on mortality and has put additional strain on already weakened health care systems. The WHO has promoted the "3Is" for TB control: intensive case finding (ICF), infection control and isoniazid preventive therapy. While the ICF strategy can increase TB case detection, there has been little attention to its use in community settings, with drug resistant TB, or HIV coinfection. Furthermore, the effect of ICF on clinical outcomes has not been studied. In this application, the candidate proposes to evaluate the impact of a community-based ICF program designed to enhance case detection of HIV, TB, and drug resistant TB. This program is being conducted at congregate settings in a highly HIV and drug susceptible and drug resistant TB prevalent, rural area of KwaZulu Natal province, South Africa. This project aims to determine the clinical outcomes of patients with HIV, TB, and MDR/XDR TB identified by the community-based ICF strategy in comparison to the traditional hospital based self-referral case finding method. This project is of great public health importance and is being conducted in cooperation with the South African provincial Department of Health. PUBLIC HEALTH RELEVANCE (provided by the applicant): Intensive case finding has been promoted by the World Health Organization as a strategy for TB control with little evidence for improved outcomes particularly with respect to HIV coinfection and MDR/XDR TB. This project will provide data on the effect of intensive case finding on clinical outcomes and inform public health policy and practice in high prevalence TB and HIV settings globally.